Aneurysmal rupture represents the most common cause of subarachnoid hemorrhage. Approximately two-thirds of persons who experience a subarachnoid hemorrhage will die or become disabled. Although advances in neurosurgical techniques, neuroanesthetic management, and neuroradiology have resulted in great progress in reducing the operative risk for patients with intracranial aneurysms, the overall outcome following subarachnoid hemorrhage remains disappointing. This article provides an overview of some current concepts related to the perioperative management of patients with intracranial aneurysms, such as the risk and management of rebleeding and vasospasm, and considerations related to the timing of surgery. The anesthetic management of these patients is reviewed, emphasizing principles relating to the facilitation of surgery--by optimizing operative conditions and minimizing the risks of intraoperative aneurysmal rupture or the aggravation of neurologic deficits--and to the provision of a smooth, stable recovery. Despite the disappointing overall prognosis following subarachnoid hemorrhage, adherence to these principles can optimize the outcome for those patients who reach the operating room.